(Prevalence of Illegal Drug Use in the US Among People Aged 12 or Older)
" In 2013, an estimated 24.6 million Americans aged 12 or older were current (past month) illicit drug users. This represents 9.4 percent of the population aged 12 or older (Table 1). Marijuana was the most commonly used illicit drug, with 19.8 million current users aged 12 or older (7.5 percent). There were 6.5 million nonmedical users of prescription-type drugs (2.5 percent), including 4.5 million nonmedical users of prescription pain relievers (1.7 percent). There were 1.5 million current cocaine users aged 12 or older, or 0.6 percent of the population. An estimated 1.3 million individuals aged 12 or older in 2013 (0.5 percent) used hallucinogens in the past month. An estimated 496,000 individuals aged 12 or older were current inhalant users, which represents 0.2 percent of the population. There were about 289,000 current heroin users aged 12 or older, or 0.1 percent of the population."

(Current Marijuana and Other Illegal Substance Use and Trends in the US, 2013)
" In 2013, an estimated 24.6 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview (Figure 2.1). The estimate represents 9.4 percent of the population aged 12 or older.
" The overall rate of current illicit drug use among persons aged 12 or older in 2013 (9.4 percent) was similar to the rates in 2010 (8.9 percent) and 2012 (9.2 percent), but it was higher than the rates in 2002 to 2009 and in 2011 (Figure 2.2).
" In 2013, marijuana was the most commonly used illicit drug, with 19.8 million current (past month) users. It was used by 80.6 percent of current illicit drug users. Nearly two thirds (64.7 percent) of current illicit drug users used only marijuana in the past month. Also, in 2013, 8.7 million persons aged 12 or older were current users of illicit drugs other than marijuana (or 35.3 percent of illicit drug users aged 12 or older). Current use of other drugs but not marijuana was reported by 19.4 percent of illicit drug users, and 15.9 percent reported using both marijuana and other drugs.
" The number and percentage of persons aged 12 or older who were current users of marijuana in 2013 (19.8 million or 7.5 percent) were similar to the estimates in 2012 (18.9 million or 7.3 percent) (Figure 2.2). The rate of current marijuana use in 2013 was higher than the rates in 2002 to 2011. For example, during the period from 2002 to 2008, the rates varied from 5.8 to 6.2 percent. By 2009, the rate increased to 6.7 percent, then continued to increase to the rate in 2013.
" An estimated 8.7 million persons aged 12 or older (3.3 percent) were current users of illicit drugs other than marijuana in 2013. The majority of these users (6.5 million persons or 2.5 percent of the population) were nonmedical users of psychotherapeutic drugs, including 4.5 million users of pain relievers (1.7 percent), 1.7 million users of tranquilizers (0.6 percent), 1.4 million users of stimulants (0.5 percent), and 251,000 users of sedatives (0.1 percent)."

(Estimated Number of Persons in the US Classified with Substance Dependence or Abuse, 2013)
" In 2013, an estimated 21.6 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8.2 percent of the population aged 12 or older) (Figure 7.1). Of these, 2.6 million were classified with dependence or abuse of both alcohol and illicit drugs, 4.3 million had dependence or abuse of illicit drugs but not alcohol, and 14.7 million had dependence or abuse of alcohol but not illicit drugs. Overall, 17.3 million had alcohol dependence or abuse, and 6.9 million had illicit drug dependence or abuse.
" The annual number of persons with substance dependence or abuse in 2013 (21.6 million) was similar to the number in each year from 2002 through 2012 (ranging from 20.6 million to 22.7 million) (Figure 7.1).
" The rate of persons aged 12 or older who had substance dependence or abuse in 2013 (8.2 percent) was similar to the rates in 2011 (8.0 percent) and 2012 (8.5 percent), but it was lower than the rate in each year from 2002 through 2010 (ranging from 8.8 to 9.4 percent).
" In 2013, 6.6 percent of the population aged 12 or older had alcohol dependence or abuse, which was similar to the rates in 2011 (6.5 percent) and 2012 (6.8 percent), but it was lower than the rate in each year from 2002 through 2010 (ranging from 7.1 to 7.8 percent).
" The rate of persons aged 12 or older who had illicit drug dependence or abuse in 2013 (2.6 percent) was similar to the rate in 2012 (2.8 percent) and in each year since 2005 (ranging from 2.5 to 2.9 percent), but it was lower than the rates in 2002 to 2004 (ranging from 2.9 to 3.0 percent).
" Marijuana was the illicit drug with the largest number of persons with past year dependence or abuse in 2013, followed by pain relievers, then by cocaine. Of the 6.9 million persons aged 12 or older who were classified with illicit drug dependence or abuse in 2013, 4.2 million persons had marijuana dependence or abuse (representing 1.6 percent of the total population aged 12 or older, and 61.4 percent of all those classified with illicit drug dependence or abuse), 1.9 million persons had pain reliever dependence or abuse, and 855,000 persons had cocaine dependence or abuse (Figure 7.2)."

(Explanation of NSDUH Method For Determining Prevalence Of Substance Use Disorders) "The National Survey on Drug Use and Health (NSDUH) includes a series of questions to assess the prevalence of substance use disorders (substance dependence or abuse) in the past 12 months. Substances include alcohol and illicit drugs, such as marijuana, cocaine, heroin, hallucinogens, inhalants, and the nonmedical use of prescription-type psychotherapeutic drugs. These questions are used to classify persons as dependent on or abusing specific substances based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (American Psychiatric Association [APA], 1994).
"The questions related to dependence ask about health and emotional problems associated with substance use, unsuccessful attempts to cut down on use, tolerance, withdrawal, reducing other activities to use substances, spending a lot of time engaging in activities related to substance use, or using the substance in greater quantities or for a longer time than intended. The questions on abuse ask about problems at work, home, and school; problems with family or friends; physical danger; and trouble with the law due to substance use. Dependence is considered to be a more severe substance use problem than abuse because it involves the psychological and physiological effects of tolerance and withdrawal."

(Global Drug Use Estimates, 2011) "In 2011, between 167 and 315 million people aged 15–64 were estimated to have used an illicit substance in the preceding year. This corresponds to between 3.6 and 6.9 per cent of the adult population. The prevalence of illicit drug use and the numbers of problem drug users — those with drug use disorders or dependence – have remained stable.1 Since 2009, the prevalence of cannabis, opioids, and opiates use has gone up, while the prevalence of use of cocaine, amphetamine-type stimulants and 'ecstasy'-group substances appears to have followed a declining trend between 2009 and 2011.2 Nevertheless, since 2008 there has been an overall 18 per cent increase in the estimated total number of people who had used an illicit substance in the preceding year, which to some extent reflects both an increase in the global population and a slight increase in the prevalence of illicit drug use."

"Marijuana use, after five years of increasing among teens, actually declined slightly in 2014, with use in the prior 12 months declining from 26 percent to 24 percent for the three grades combined.
"'The belief that regular marijuana use harms the user, however, continues to fall among youth, so changes in this belief do not seem to explain the change in use this year, as it has done over most of the life of the study,' Johnston said.
"Personal disapproval of use is also down some in 8th and 12th grades. Reported availability, on the other hand, is down significantly since 2013 in the two lower grades (and unchanged in 12th grade), which may help to explain the modest decline in use this year.
"Current daily or near-daily marijuana use—defined as use on 20 or more occasions in the prior 30 days—also declined some in 2014; nonetheless, it remains quite high. About one in every 17 high school seniors in 2014 (5.8 percent) is a current daily or near-daily marijuana user, which is down from 6.5 percent in 2013.
"An index of using any illicit drug other than marijuana in the prior 12 months declined by 1.9 percent (not a statistically significant change) to 15.9 percent in 12th grade; but in 8th and 10th grades the prevalence was virtually unchanged and stood at 6.4 percent and 11.2 percent, respectively."

(Prevalence of Marijuana Use Among Youth in the US, 2012) "Annual marijuana prevalence peaked among 12th graders in 1979 at 51%, following a rise that began during the 1960s. Then use declined fairly steadily for 13 years, bottoming at 22% in 1992—a decline of more than half. The 1990s, however, saw a resurgence of use. After a considerable increase (one that actually began among 8th graders a year earlier than among 10th and 12th graders), annual prevalence rates peaked in 1996 at 8th grade and in 1997 at 10th and 12th grades. After these peak years, use declined among all three grades through 2006, 2007, or 2008; after the declines, there began an upturn in use in all three grades, lasting for three years in the lower grades and longer in grade 12. In 2011 and 2012 there was some decline in use in grade 8, with 10th and 12th grades leveling in 2012. In 2010 a significant increase in daily use occurred in all three grades, followed by a nonsignificant increase in 2011. In 2012 there were non-significant declines for daily use in the lower grades and a leveling at 12th grade with use reaching 1.1%, 3.5%, and 6.5% in grades 8, 10, and 12, respectively."

(Initiation of Substance Use By People 12 Or Older In The US, 2013)
" In 2013, an estimated 2.8 million persons aged 12 or older used an illicit drug for the first time within the past 12 months; this averages to about 7,800 new users per day. This estimate was similar to the 2012 estimate of 2.9 million. Over half of initiates (54.1 percent) were younger than age 18 when they first used, and 58.3 percent of new users were female. The 2013 average age at initiation among persons aged 12 to 49 was 19.0 years, which was similar to the 2012 estimate (18.7 years). See Section B.4.1 in Appendix B for a discussion of the effects of older adult initiates on estimates of mean age at first use.
" Of the estimated 2.8 million persons aged 12 or older in 2013 who used illicit drugs for the first time within the past 12 months, a majority reported that their first drug was marijuana (70.3 percent) (Figure 5.1). About 1 in 5 initiated with nonmedical use of psychotherapeutics (20.6 percent, including 12.5 percent with pain relievers, 5.2 percent with tranquilizers, 2.7 percent with stimulants, and 0.2 percent with sedatives). A notable proportion reported inhalants (6.3 percent) as their first illicit drug, and a small proportion used hallucinogens (2.6 percent). The percentage of persons in 2013 reporting marijuana as the first illicit drug in past year initiation was greater than the corresponding percentage in 2012 (70.3 vs. 65.6 percent). The percentage reporting nonmedical use of pain relievers as the first illicit drug was lower in 2013 than in 2012 (12.5 vs. 17.0 percent)."

(Prevalence of Substance Use Among Youth in the US, 2012, by Race/Ethnicity)
" Two general points can be derived from the tables. First, for a number of years, 12th-grade African-American students reported lifetime, annual, 30-day, and daily prevalence rates for nearly all drugs that were lower—sometimes dramatically so—than those for White or Hispanic 12th graders. That is less true today. Second, use rates for most drugs were generally lower for African-American students in 8th and 10th grades, as well; therefore, their low usage rates in 12th grade were almost certainly not due to differential dropout rates. These differences are also less observable in 2013.
" The association between annual marijuana use and race/ethnicity varies by grade level. Hispanic students have the highest rate in all three grades in 2013. White students have the lowest rate of marijuana use in 8th and 10th grades but the second highest in 12th grade. African-American students have the second highest in 8th and 10th grades but are very close to Whites in 12th grade.
" A number of drugs have consistently been much less popular among African-American teens than among White teens. These include hallucinogens, amphetamines, methamphetamine, sedatives (barbiturates), tranquilizers, and narcotics other than
heroin. Several additional drugs have historically been less popular among African-American teens but did not show much difference in 2013 among 8th graders, though they still are less popular in the upper grades. These include inhalants, LSD, ecstasy, cocaine (in recent years), powder cocaine, OxyContin, Vicodin, Ritalin, and Adderall.
" By 12th grade, White students have the highest lifetime and annual prevalence rates among the three major racial/ethnic groups for many substances, including synthetic marijuana, LSD, hallucinogens other than LSD, narcotics other than heroin, amphetamines,sedatives (barbiturates), tranquilizers, been drunk, occasions of heavy drinking in the last two weeks, cigarettes, and smokeless tobacco. The differentials for LSD have narrowed considerably in recent years as overall prevalence has declined substantially for this drug. Not all of these findings are replicated at lower grade levels, however. See Tables 4-5 and 4-6 for specifics."

(Cocaine & Crack Use and Perceived Risk Among Youth) "According to the 2009 Monitoring the Future survey—a national survey of 8th-, 10th-, and 12th-graders—there were continuing declines reported in the use of powder cocaine, with past-year** usage levels reaching their lowest point since the early 1990s. Significant declines in use were measured from 2008 to 2009 among 12th-graders across all three survey categories: lifetime use decreased from 7.2 percent to 6.0 percent; past-year use dropped from 4.4 percent to 3.4 percent; and past-month use dropped from 1.9 percent to 1.3 percent. Survey measures showed other positive findings among 12th-graders as well; their perceived risk of harm associated with powder cocaine use increased significantly during the same period. Additionally, survey participants in the 10th grade reported significant changes, with past-month use falling from 1.2 percent in 2008 to 0.9 percent in 2009."

(Current Illicit Drug Use In The US By People 12 Or Older, 2013, by Race/Ethnicity)
" In 2013, among persons aged 12 or older, the rate of current illicit drug use was 3.1 percent among Asians, 8.8 percent among Hispanics, 9.5 percent among whites, 10.5 percent among blacks, 12.3 percent among American Indians or Alaska Natives, 14.0 percent among Native Hawaiians or Other Pacific Islanders, and 17.4 percent among persons reporting two or more races.
" There were no statistically significant differences in the rates of current illicit drug use between 2012 and 2013 for any of the racial/ethnic groups. Between 2002 and 2013, the rate of current illicit drug use increased from 8.5 to 9.5 percent for whites. Among blacks, the rate increased from 8.7 percent in 2003 and 2004 to 10.5 percent in 2013 (Figure 2.12)."

(Use of Crack & Cocaine by Youth in the US 2013, by Race/Ethnicity)
" Hispanics now have the highest annual prevalence rates for crack and cocaine in all three grade levels. The rate of cocaine use by Hispanic students has tended to be high compared to the other two racial/ethnic groups, particularly in the lower grades. It bears repeating that Hispanics have a considerably higher dropout rate than Whites or African Americans, based on Census Bureau statistics, which would tend to diminish any such differences by 12th grade.
" An examination of racial/ethnic comparisons at lower grade levels shows Hispanics having higher rates of use of many of the substances on which they have the highest prevalence of use in 12th grade, as well as for several other drugs For example, other cocaine (i.e., powder cocaine) has a lifetime prevalence in 8th grade for Hispanics, Whites, and African Americans of 3.4%, 1.4%, and 1.0%, respectively. In fact, in 8th grade—before most dropping out occurs—Hispanics have the highest rates of use of almost all substances, whereas by 12th grade Whites have the highest rates of use of most. Certainly the considerably higher dropout rate among Hispanics could explain this shift, and it may be the most plausible explanation. Another explanation worth consideration is that Hispanics may tend to start using drugs at a younger age, but Whites overtake them at older ages. These explanations are not mutually exclusive, of course, and to some degree both explanations may hold true.41"

(Substance Abuse or Dependence in the US by Race/Ethnicity, 2013)
" In 2013, among persons aged 12 or older, the rate of substance dependence or abuse was 4.6 percent among Asians, 7.4 percent among blacks, 8.4 percent among whites, 8.6 percent among Hispanics, 10.9 percent among persons reporting two or more races, 11.3 percent among Native Hawaiians or Other Pacific Islanders, and 14.9 percent among American Indians or Alaska Natives. Except for Native Hawaiians or Other Pacific Islanders, the rate for Asians was lower than the rates for the other racial/ethnic groups."

(Alcohol Use In The US By Race/Ethnicity, 2013)
" Among persons aged 12 or older, whites in 2013 were more likely than other racial/ethnic groups to report current use of alcohol (57.7 percent) (Figure 3.3). The rates were 47.4 percent for persons reporting two or more races, 43.6 percent for blacks, 43.0 percent for Hispanics, 38.4 percent for Native Hawaiians or Other Pacific Islanders, 37.3 percent for American Indians or Alaska Natives, and 34.5 percent for Asians.
" The rate of binge alcohol use in 2013 was lowest among Asians (12.4 percent) (Figure 3.3). Rates for other racial/ethnic groups were 19.6 percent for persons reporting two or more races, 20.1 percent for blacks, 23.5 percent for American Indians or Alaska Natives 24.0 percent for whites, 24.1 percent for Hispanics, and 24.7 percent for Native Hawaiians or Other Pacific Islanders.
" Among youths aged 12 to 17 in 2013, rates of current alcohol use were 8.0 percent among Asians, 8.2 percent for Native Hawaiians or Other Pacific Islanders, 9.0 percent for those reporting two or more races, 9.3 percent for American Indians or Alaska Natives, 9.7 percent for blacks, 10.7 percent for Hispanics, and 12.9 percent for whites. The rates for Hispanic and white youths were lower than those reported in 2012 (12.8 and 14.6 percent, respectively)."

(Alcohol Use Among African-Americans In The US, 2002-2008) "Past month alcohol use, binge alcohol use, and illicit drug use remained relatively stable among black adults between 2002 and 2008 (Figure1).4,5
"Combined 2004 to 2008 data indicate that, in the past month, 44.3 percent of black adults used alcohol, 21.7 percent reported binge alcohol use, and 9.5 percent used an illicit drug (Figure 2).
"Rates of past month alcohol use and binge alcohol use were lower among black adults than the national averages. The rate of past month illicit drug use among black adults, however, was higher than the national average.
"Rates of past month and binge alcohol use were considerably lower among young black adults than the national average of young adults (48.6 vs. 61.1 percent and 25.3 vs. 41.6 percent, respectively) (Figure 3). Past month illicit drug use among young black adults was slightly lower than the national average (18.7 vs. 19.7 percent).
"Older black adults had a rate of past month alcohol use that was considerably lower than the national average of older adults (20.3 vs. 38.3 percent) (Figure 4). Their rates of binge alcohol use and past month illicit drug use, however, did not differ significantly from the national averages.
"Compared with the national averages, adult black females had lower rates of past month alcohol use and binge alcohol use and a slightly higher rate of past month illicit drug use (Table 1).
"Compared with the national averages, adult black males had lower rates of past month alcohol use and binge alcohol use and a slightly higher rate of past month illicit drug use (Table 2)."

(Prevalence of Use Among Hispanics in the US, 2008))
"● Rates of past month alcohol use and illicit drug use were lower among Hispanic adults than the national averages for adults (46.1 vs. 55.2 percent and 6.6 vs. 7.9 percent, respectively); however, past month binge alcohol use was higher among Hispanics than the national average (26.3 vs. 24.5 percent)
"● Among Hispanic adults, substance use varied greatly by subgroup; past month illicit drug use, for example, ranged from a high of 13.1 percent among adults of Spanish origin (from Spain) to a low of 3.9 percent among those of Dominican origin
"● Hispanic adults who were born in the United States had higher rates of past month substance use than Hispanic adults who were not born in the United States, regardless of age
"● Among Hispanics who needed treatment for an alcohol or illicit drug problem, the percentage who received such treatment did not differ significantly from the national average"

(Substance Use by Hispanic Youth in the US) "Fifty-two percent of Hispanic youth report using illicit drugs in the past year (vs. 42 percent for African-American youth and 40 percent for Caucasian teens). They are also more likely than other teens to have used prescription medicine, Ecstasy or cocaine/crack to get high.
"Marijuana use levels are of significant concern among Hispanic youth. Half of Hispanic teens report smoking marijuana in the past year (43 percent more than Caucasian teens and 25 percent more than African-American youth)."

(Estimated Substance Use In The US, 2013, By Gender)
" In 2013, as in prior years, the rate of current illicit drug use among persons aged 12 or older was higher for males (11.5 percent) than for females (7.3 percent). Males were more likely than females to be current users of several different illicit drugs, including marijuana (9.7 vs. 5.6 percent), cocaine (0.8 vs. 0.4 percent), and hallucinogens (0.7 vs. 0.3 percent).
" In 2013, the rate of current illicit drug use was higher for males than females aged 12 to 17 (9.6 vs. 8.0 percent). This represents a change from 2012, when the rates of current illicit drug use were similar among males and females aged 12 to 17 (9.6 and 9.5 percent, respectively), and reflects a decrease in the rate of current illicit drug use among females from 2012 to 2013. Likewise, in 2013, the rate of current marijuana use was higher for males than females aged 12 to 17 (7.9 vs. 6.2 percent), which is a change from 2012 when the rates of current marijuana use for males and females were similar (7.5 and 7.0 percent).
" The rate of current marijuana use among males aged 12 to 17 declined from 9.1 percent in 2002 to 6.9 percent in 2006, then increased between 2006 and 2011 (9.0 percent) (Figure 2.11). The rate decreased from 2011 to 2012 (7.5 percent) and remained stable in 2013 (7.9 percent). Among females aged 12 to 17, the rate of current marijuana use decreased from 7.2 percent in 2002 and 2003 to 6.2 percent in 2013."

(Estimated Prevalence of Marijuana Use in the US, 2013)
" Marijuana was the most commonly used illicit drug in 2013. There were 19.8 million past month users in 2013 (7.5 percent of those aged 12 or older), which was similar to the number and rate in 2012 (18.9 million or 7.3 percent). The 2013 rate was higher than the rates in 2002 to 2011 (ranging from 5.8 to 7.0 percent). Marijuana was used by 80.6 percent of current illicit drug users in 2013.
" Daily or almost daily use of marijuana (used on 20 or more days in the past month) increased from 5.1 million persons in 2005 to 2007 to 8.1 million persons in 2013."

(Prevalence of Marijuana Use Among Full-Time Workers in the US)
" An estimated 6.4 percent, or 7.3 million, of full-time workers reported use of marijuana during the past month (Tables 2.2 and 2.3).
" Adults aged 26 to 34 were only about half as likely as 18- to 25-year-olds to be past month marijuana users (8.0 vs. 15.9 percent). Past month use of marijuana was lower with increasing age (Table 2.2).
" The prevalence of past month marijuana use was higher for males than females (7.9 vs. 4.3 percent, respectively) (Table 2.2).
" An estimated 11.0 percent of workers reporting two or more races used marijuana during the past month. This was higher than among non-Hispanic white adults (6.9 percent). Fewer Hispanic adults (4.6 percent) reported past month marijuana use than non-Hispanic white adults who reported two or more races (Table 2.2).
" Higher educational attainment and higher family income were associated with a lower prevalence of current marijuana use (Table 2.3)."

(Prevalence of Daily Or Almost Daily Marijuana Use in the US, 2013)
" In 2013, 5.7 million persons aged 12 or older used marijuana on a daily or almost daily basis in the past 12 months (i.e., on 300 or more days in that period), which was an increase from the 3.1 million daily or almost daily users in 2006 (Figure 2.15). The number of daily or almost daily users of marijuana in 2013 represented 17.4 percent of past year users.
" In 2013, 8.1 million persons aged 12 or older used marijuana on 20 or more days in the past month, which was an increase from the 5.1 million daily or almost daily past month users in 2005 to 2007 (Figure 2.15). The number of daily or almost daily users in 2013 represented 41.1 percent of past month marijuana users."

(Global Prevalence of Cannabis Use) "Cannabis use has increased globally, particularly in Asia since 2009. Although epidemiological data is not available, experts from the region report a perceived increase in use. The regions with a prevalence of cannabis use that is higher than the global average continue to be West and Central Africa (12.4 per cent), Oceania (essentially Australia and New Zealand, 10.9 per cent), North America (10.7 per cent) and Western and Central Europe (7.6 per cent). Cannabis use in North America and in most parts of Western and Central Europe is considered to be stable or declining."

(Current Cocaine Use in the US, 2013)
" The number and percentage of persons aged 12 or older who were current users of cocaine in 2013 (1.5 million or 0.6 percent) were similar to those in 2009 to 2012 (ranging from 1.4 million to 1.7 million or from 0.5 to 0.7 percent), but were lower than those in 2002 to 2007 (ranging from 2.0 million to 2.4 million or from 0.8 to 1.0 percent) (Figure 2.2)."

(Initiation of Cocaine or Crack Use in the US, 2013)
" In 2013, there were 601,000 persons aged 12 or older who had used cocaine for the first time within the past 12 months; this averages to approximately 1,600 initiates per day. This estimate was similar to the number in 2008 to 2012 (ranging from 623,000 to 724,000). The annual number of cocaine initiates in 2013 was lower than the estimates from 2002 through 2007 (ranging from 0.9 million to 1.0 million).
" The number of initiates of crack cocaine ranged from 209,000 to 353,000 in 2002 to 2008 and declined to 95,000 in 2009. The number of initiates of crack cocaine has been similar each year since 2009 (e.g., 58,000 in 2013).
" In 2013, most (81.9 percent) of the 0.6 million recent cocaine initiates were aged 18 or older when they first used. The average age at first use among recent initiates aged 12 to 49 was 20.4 years. The average age estimates have remained fairly stable since 2002."

(Global Prevalence of Cocaine Use, 2011) "The two major markets for cocaine, North America and Western and Central Europe, registered a decrease in cocaine use between 2010 and 2011, with annual prevalence among the adult population in Western and Central Europe decreasing from 1.3 per cent in 2010 to 1.2 per cent in 2011, and from 1.6 per cent to 1.5 per cent in North America. While cocaine use in many South American countries has decreased or remained stable, there has been a substantial increase in Brazil that is obvious enough to be reflected in the regional prevalence rate for 2011. Australia has also reported an increase in cocaine use."

(Current Heroin Use in the US, 2013)
" The number and percentage of persons aged 12 or older who were current heroin users in 2013 (289,000 or 0.1 percent) were similar to those in 2008 to 2012 (ranging from 193,000 to 335,000 or 0.1 percent for all 4 years) (Figure 2.4). The number of current heroin users in 2013 was higher than the number of users in 2002 to 2005 (ranging from 119,000 to 166,000) and in 2007 (161,000). The number of persons aged 12 or older who were past year heroin users in 2013 also was higher than the numbers in 2002 to 2005, 2007, and 2008 (ranging from 314,000 to 455,000). (See Section B.2.3 in Appendix B for additional discussion of the estimated numbers of past year and past month heroin users in 2006.)"

(Global Opioid Use Rates, 2011) "The use of opioids (heroin, opium and prescription opioids) has increased in Asia since 2009, particularly in East, South-East, Central and South-West Asia. While reliable data do not exist for most parts of Africa, experts report an increase in the use of opioids there. North America 3.9 per cent), Oceania (3.0 per cent), the Near and Middle
East/South-West Asia (1.9 per cent) and East and South-Eastern Europe (1.2 per cent) show a prevalence of opioid use that is higher than the global average. The use of opiates (heroin and opium) has remained stable in some regions, nevertheless, a high prevalence is reported in the Near and Middle East/South-West Asia (1.2 per cent), primarily in Afghanistan, Iran (Islamic Republic of ) and Pakistan, as well as Central Asia (0.8 per cent), Eastern and South-Eastern Europe (0.8 per cent), North America (0.5 per cent) and West and Central Africa (0.4 per cent)."

(Global Estimated Prevalence of IDU-Related HIV, 2011) "Of the estimated 14.0 million (range: 11.2 million to 22.0 million) people who inject drugs worldwide, UNODC estimates that 1.6 million (range: 1.2 million to 3.9 million) are living with HIV. That represents a global prevalence of HIV of 11.5 per cent among people who inject drugs.15
"Along with the estimates of the total number of people who inject drugs, the global total and prevalence rates of people who inject drugs living with HIV for 2011 is also lower than the estimated 3 million (18.9 per cent prevalence among people who inject drugs) previously presented by the Reference Group to the United Nations on HIV and Injecting Drug Use for 2008. These reduced estimates are in large part a result of the availability of more reliable information on HIV prevalence among people who inject drugs."

(Global Estimate of Prevalence of Injection Drug Use) "Updating the previous global estimates, the United Nations Office on Drugs and Crime (UNODC) estimates that in 2011 a total of 14.0 million (range: 11.2 million to 22.0 million) people injected drugs worldwide, which corresponds to 0.31 per cent (range: 0.24-0.48 per cent) of the population aged 15-64.14 The current global estimates are lower than the previous ones of 15.9 million people, and primarily reflect the fact that many countries have revised their earlier estimates downward, based on behavioural surveillance data. However, many countries have also reported an increase in the prevalence of injecting drug use and in the number of people who inject drugs.
"Changes over time in national, regional and global estimates of injecting drug use may result from a number of factors, such as improvements in the methodology or coverage of behavioural surveillance (e.g., Georgia, Italy and South Africa), additional countries undertaking behavioural surveillance for the first time (Kenya and Seychelles) or changes in patterns of drug use, including injecting drug use (Australia and Brazil). Such factors have contributed to the overall reduced global estimates of people who inject drugs. Notable increases in the estimated number of people who inject drugs have been reported from Pakistan, the Russian Federation and Viet Nam, while countries reporting a considerable reduction include Brazil, Indonesia, South Africa, Thailand and the United States."

(Current Methamphetamine Use in the US, 2012)
" The number and percentage of persons aged 12 or older who were current users of methamphetamine in 2013 (595,000 or 0.2 percent) were similar to those in 2012 (440,000 or 0.2 percent) and 2011 (439,000 or 0.2 percent). However, the estimates in 2013 were higher than those in 2010 (353,000 or 0.1 percent)."

(Global Amphetamine-Type Stimulant Use, 2011) "Use of ATS, excluding 'ecstasy', remains widespread globally, and appears to be increasing. Although prevalence estimates are not available from Asia and Africa, experts from these regions continue to report a perceived increase in the use of ATS. While the use of ATS was already a problem in East and South-East Asia, there are reports of increasing diversion of precursor chemicals, as well as increased seizures and manufacture of methamphetamine, combined with an increase in its use. Current data from the drug use survey in Pakistan, for instance supports this assessment. Use of ATS is emerging in Pakistan, with a reported annual prevalence of 0.1 per cent among the general population.3 High levels of ATS use are reported in Oceania (2.1 per cent in Australia and New Zealand), Central and North America (1.3 per cent each) and Africa (0.9 per cent), while the estimated annual prevalence of ATS use in Asia (0.7 per cent) is comparable with the global average."

(Global Estimated Prevalence of Injection Drug Use, by Region) "At a regional level, a high prevalence of injecting drug use is found in Eastern and South-Eastern Europe (1.3 per cent of the population aged 15-64), where the percentage of people who inject drugs is four times greater than the global average and which alone accounts for 21 per cent of the total number of people who inject drugs globally.
"A high prevalence rate for injecting drug use is also noted in Central Asia (1.3 per cent), which has a rate of more than four times the global average. Injecting drug use also remains a serious public health concern in a number of countries in East and South-East Asia, with the region accounting for 27 per cent of the global total. South Asia has the lowest level of injecting drug use (0.03 per cent, mostly as a result of the low prevalence rate reported in India), considerably lower than that of any other region.
"Countries and areas with the highest rates of injecting drug use – more than 3.5 times the global average — are Azerbaijan (5.2 per cent), Seychelles (2.3 per cent), the Russian Federation (2.3 per cent), Estonia (1.5 per cent), Georgia (1.3 per cent), Canada (1.3 per cent), the Republic of Moldova (1.2 per cent), Puerto Rico (1.15 per cent), Latvia (1.15 per cent) and Belarus (1.11 per cent). China, the Russian Federation and the United States are the countries with the largest numbers of people who inject drugs. Combined, they account for an estimated 46 per cent, or nearly one in two, people who inject drugs globally."

(Current Nonmedical Use of Psychotherapeutics in the US, 2013)
" The percentage of persons aged 12 or older who were current nonmedical users of psychotherapeutic drugs in 2013 (2.5 percent) was lower than the percentages in 2006, 2007, and 2009 (ranging from 2.8 to 2.9 percent), but it was similar to the percentages in all of the other years from 2002 to 2012 (ranging from 2.4 to 2.7 percent) (Figure 2.2). The number of persons aged 12 or older who were current nonmedical users of psychotherapeutic drugs in 2013 (6.5 million) was similar to the number of users in 2002 to 2012 (ranging from 6.1 million to 7.1 million)."

(Prevalence of Illicit Drug Use Among Full-Time Employees in the US, )
" The prevalence of past month illicit drug use among adult full-time workers was 8.2 percent (Figure 2.3 and Tables 2.2 and 2.3).
" Nearly one out of five (19.0 percent) workers aged 18 to 25 used illicit drugs during the past month. This was a higher percentage than among the 26-to-34 (10.3 percent), 35-to-49 (7.0 percent), and 50-to-64 (2.6 percent) age groups (Figure 2.3 and Table 2.2).
" Males were more likely than females to report past month illicit drug use (9.7 vs. 6.2 percent). Males accounted for about two thirds (6.4 million) of the workers who reported past month illicit drug use (Figure 2.4 and Table 2.2).
" The prevalence of past month illicit drug use for white adults was 8.8 percent, higher than the prevalence for Asian (2.2 percent) or Hispanic (6.7 percent) adults, and lower than that reported for adults who reported two or more races (13.5 percent). The prevalence of past month illicit drug use by Asians was lower than that reported by all other racial/ethnic groups reported here (Figure 2.5 and Table 2.2)."

(Current Nonmedical Use of Pain Relievers in the US, 2013)
" The number and percentage of persons aged 12 or older who were current nonmedical users of pain relievers in 2013 (4.5 million or 1.7 percent) were similar to those in 2011 and 2012 (4.5 million and 4.9 million, respectively, or 1.7 and 1.9 percent) (Figure 2.3).
" The number and percentage of persons aged 12 or older who were current nonmedical users of the pain reliever OxyContin® in 2013 (492,000 or 0.2 percent) were similar to the numbers in 2007 to 2012 (ranging from 358,000 to 566,000 or 0.1 to 0.2 percent)."

(Current Nonmedical Use of Prescription Stimulants in the US, 2013)
" The number and percentage of persons aged 12 or older who were current nonmedical users of stimulants in 2013 (1.4 million or 0.5 percent) were similar to those in 2012 (1.2 million or 0.5 percent), but were higher than the estimates in 2011 (970,000 or 0.4 percent)."

(Nonmedical Use of Ritalin and Adderal by US Youth)
" Use of the amphetamine Ritalin outside of medical supervision showed a distinct increase around 1997—with annual prevalence among 12th graders going from 0.1% in 1992 to 2.8% in 1997—and then stayed level for a few years (see appendix E in Volume I, Table E-211). Because of its increasing importance, a differently structured question was introduced for Ritalin use in 2001 (2002 in the follow-ups of college students and young adults). This new question, which we prefer to the original, does not use a prior branching question and produced somewhat higher prevalence rates. Results from the new question suggest an ongoing, gradual decline in Ritalin use, which continued into 2009 in all five populations. The decline continued further in 2012 among 8th graders, and until 2013 among 10th graders, Ritalin use leveled around 2010 among 12th graders. College students, but not all young adults, showed a nonsignificant increase in use in 2013.
" Another amphetamine used in the treatment of the symptoms of attention deficit hyperactivity disorder (ADHD) is Adderall. A new question on its use was introduced in 2009; annual prevalence rates in 2009 through 2013 were higher than those for Ritalin in all five populations. This suggests that Adderall may have to some degree replaced the use of Ritalin and may help to account for the declines that we have been observing for the latter drug. Annual prevalence of Adderall changed rather little between 2009 and 2013 in 8th and 10th grades, although the rates seem to be drifting down. In 12th grade, however, annual prevalence has risen from 5.4% in 2009 to 7.6% in 2012 and leveled in 2013. The absolute prevalence rates are fairly high, particularly among 12th graders (7.4%) and college students (10.7% in 2013)."

(Prevalence of Illicit Drug Dependence or Abuse Among Full-Time Workers in the US)
" Approximately 3 million full-time workers (2.6 percent) aged 18 to 64 met the criteria for past year illicit drug dependence or abuse (Figure 2.3 and Table 2.4).
" Approximately 7.5 percent of 18- to 25-year-old workers had past year illicit drug dependence or abuse. This was higher than among all other age groups studied (26- to 34-year-olds [3.3 percent], 35- to 49-year-olds [1.9 percent], and 50- to 64-year-olds [0.7 percent]) (Figure 2.3 and Table 2.4).
" Males were nearly twice as likely as females to meet the criteria for past year illicit drug dependence or abuse (3.3 vs. 1.8 percent) (Figure 2.4 and Table 2.4).
" Hispanics (3.2 percent) had a higher prevalence of past year illicit drug dependence or abuse than non-Hispanics (2.6 percent) (Figure 2.8 and Table 2.4).
" Within non-Hispanic subgroups, Asians had the lowest prevalence of past year illicit drug dependence or abuse (1.1 percent). This was lower than non-Hispanic white adults (2.5 percent), black (2.9 percent) adults, American Indian or Alaska Native (4.5 percent) adults, and adults reporting two or more races (4.3 percent) (Figure 2.8 and Table 2.4)."

(Initiation of Nonmedical Use of Prescription Psychotherapeutics in the US, 2013)
" Nonmedical use of psychotherapeutics includes nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included. In 2013, there were approximately 2.0 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year, which averages to about 5,500 initiates per day. The number of new nonmedical users of psychotherapeutics in 2013 was lower than the estimates for prior years from 2002 through 2012 (ranging from 2.3 million to 2.8 million).
" In 2013, the numbers of initiates were 1.5 million for pain relievers, 1.2 million for tranquilizers, 603,000 for stimulants, and 128,000 for sedatives (Figure 5.6).
" The number of new nonmedical users of pain relievers in 2013 (1.5 million) was lower than the numbers in 2002 through 2012 (ranging from 1.9 million to 2.5 million) (Figure 5.6). The number of past year initiates for nonmedical use of tranquilizers has been fairly stable from 2002 to 2013 (ranging from 1.1 million to 1.4 million). The number of initiates for nonmedical use of stimulants in 2013 was similar to the numbers in 2003, 2005, and in 2007 to 2012 (ranging from 602,000 to 715,000), but was lower than the numbers in 2002, 2004, and 2006 (ranging from 783,000 to 846,000). The number of initiates for nonmedical use of sedatives in 2013 was similar to the numbers in 2002, 2003, 2007 to 2009, 2011, and 2012 (ranging from 159,000 to 209,000), but was lower than the numbers in 2004 to 2006 and in 2010 (ranging from 240,000 to 267,000).
" In 2013, the average age at first nonmedical use of any psychotherapeutics among recent initiates aged 12 to 49 was 22.4 years. Average ages at first nonmedical use were 21.6 years for stimulants, 21.7 years for pain relievers, 25.0 years for sedatives, and 25.4 years for tranquilizers. All of these 2013 estimates were similar to the corresponding estimates in 2012.
" In 2013, the number of new nonmedical users of OxyContin® aged 12 or older was 436,000, which was similar to the estimates for prior years from 2004 through 2012. The average age at first use of OxyContin® among past year initiates aged 12 to 49 was similar in 2012 and 2013 (22.0 and 23.6 years, respectively)."

(Prescription Antidepressant Use in the US) "Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005–2008 and the most frequently used by persons aged 18–44 years. From 1988–1994 through 2005–2008, the rate of antidepressant use in the United States among all ages increased nearly 400%."

(Nonmedical Prescription Drug Use by Young Adults Aged 18-25 in the US, 2013)
" Among young adults aged 18 to 25, the rate of current nonmedical use of psychotherapeutic drugs in 2013 (4.8 percent) was similar to the rates in 2011 (5.0 percent) and 2012 (5.3 percent), but it was lower than the rates in 2002 to 2010 (ranging from 5.5 to 6.5 percent) (Figure 2.9). The rate of current nonmedical use of pain relievers among young adults in 2013 (3.3 percent) was lower than the rates in 2012 (3.8 percent) and in 2002 to 2010 (ranging from 4.1 to 5.0 percent), but it was similar to the rate in 2011 (3.6 percent)."

(Nonmedical Use of Psychotherapeutic Drugs by Type, 2004) "In 2004, 6.0 million persons were current users of psychotherapeutic drugs taken nonmedically (2.5 percent). These include 4.4 million who used pain relievers, 1.6 million who used tranquilizers, 1.2 million who used stimulants, and 0.3 million who used sedatives. These estimates are all similar to the corresponding estimates for 2003.
"There were significant increases in the lifetime prevalence of use from 2003 to 2004 in several categories of pain relievers among those aged 18 to 25. Specific pain relievers with statistically significant increases in lifetime use were Vicodin®, Lortab®, or Lorcet® (from 15.0 to 16.5 percent); Percocet®, Percodan®, or Tylox® (from 7.8 to 8.7 percent); hydrocodone products (from 16.3 to 17.4 percent); OxyContin® (from 3.6 to 4.3 percent); and oxycodone products (from 8.9 to 10.1 percent)."

(Prevalence of New Psychoactive Substances (NPS) Among US Youth) "In the United States, the ‘Monitoring the Future’ survey has been conducted annually since 1975 to generate national data on drug use of American adolescents, college students and adults through the age of 50. In 2011, a question about the use of synthetic cannabinoids (‘spice’ and K2)169 was included for the first time in the survey, asking 12th graders about their use in the previous 12 months. The sample size of the 2011 survey encompassed about 46,700 secondary school students in 400 schools nationwide.170 According to the findings of the survey, synthetic cannabinoids ranked second only to natural cannabis in annual prevalence among 12th graders. Some 11.4% of 12th graders reported having used synthetic cannabinoids in the previous 12 months, while 5.9% of these users reported last year use of salvia divinorum. Overall, last-year use of NPS among 12th graders surpassed the use of other illicit drugs such as cocaine (2.9%) and heroin (0.80%) in 2011. Among all young adults aged 19-30, the annual prevalence of synthetic cannabinoids was 6.5%, but there were considerable differences by age. With annual prevalence rates in 2011 between 2% and 5%, salvia divinorum seems to be more widespread among 19-24 years olds than among those aged 25 to 30, where annual prevalence was less than 1%."

(Global Prevalence of Ecstasy Use, 2012) "With between 9.4 million and 28.2 million estimated past-year users in 2012, its use declined globally in the period 2010-2012, mainly in Western and Central Europe. Nevertheless, Oceania (2.9 per cent), North America (0.9 per cent) and Europe (0.5 per cent) remain regions with prevalence rates higher than the global average of 0.4 per cent."

(Current Hallucinogen Use in the US, 2013)
" The number and percentage of persons aged 12 or older who were current users of hallucinogens in 2013 (1.3 million or 0.5 percent) were similar to those in 2012 (1.1 million or 0.4 percent), but were higher than in 2011 (1.0 million or 0.4 percent) (Figure 2.2)."

(Prevalence of Current Alcohol Use, Binge Drinking, and Heavy Drinking in the US, 2013)
" Slightly more than half (52.2 percent) of Americans aged 12 or older reported being current drinkers of alcohol in the 2013 survey, which was similar to the rate in 2012 (52.1 percent). This translates to an estimated 136.9 million current drinkers in 2013.
" Nearly one quarter (22.9 percent) of persons aged 12 or older in 2013 were binge alcohol users in the 30 days prior to the survey. This translates to about 60.1 million people. The rate in 2013 was similar to the rate in 2012 (23.0 percent).
" In 2013, heavy drinking was reported by 6.3 percent of the population aged 12 or older, or 16.5 million people. This percentage was similar to the rate of heavy drinking in 2012 (6.5 percent)."

(Prevalence of Heavy Alcohol Use Among Full-Time Workers in the US)
" An estimated 8.8 percent, or 10.1 million, of full-time workers reported past month heavy alcohol use (Figure 2.3 and Tables 2.2 and 2.3).
" Past month heavy alcohol use was related to age. Among younger workers (18 to 25 years old), 16.3 percent reported past month heavy alcohol use compared with 10.4 percent of 26- to 34-year-olds, 8.1 percent of 35- to 49-year-olds, and 4.7 percent of 50- to 64-year-olds (Figure 2.3 and Table 2.2).
" Males were three times as likely as females to be past month heavy alcohol users (12.3 vs. 4.1 percent) (Figure 2.4 and Table 2.2).
" An estimated 10.1 percent of white adults reported heavy alcohol use in the past month. This was higher than the percentage among black adults (5.4 percent), Asian adults (2.9 percent), Hispanic adults (6.9 percent), and adults reporting two or more races (7.5 percent) (Figure 2.5 and Table 2.2).
" Residents of noncore rural counties had a lower prevalence of past month heavy alcohol use (7.5 percent) compared with residents of micropolitan statistical area (9.2 percent), small MSA (9.8 percent), and large MSA (8.1 percent) counties (Table 2.3).
" Workers with a college education had a lower prevalence of past month heavy alcohol use compared with those without a college education. Past month heavy alcohol use was lower among those with higher levels of education than those with less education (college graduate [6.7 percent] vs. less than high school [10.8 percent]) (Figure 2.6 and Table 2.3)."

(Other Substance Use by 'Lifetime' Alcohol Users in the US) "Lifetime alcohol users aged 21 or older had a significantly higher rate of past year illicit drug use (13.7 percent) compared with lifetime nondrinkers (2.7 percent). In addition, lifetime alcohol users had significantly higher rates of past year use across all illicit drug categories, with the exception of inhalants (Table 1). Nonmedical use of pain relievers was the illicit drug used most often by lifetime nondrinkers, whereas lifetime alcohol users reported using marijuana most frequently."

('Lifetime' Alcohol Users and Other Drug Use) "In 2002 and 2003, an estimated 88.2 percent of persons aged 21 or older (175.6 million) were lifetime alcohol users, whereas an estimated 11.8 percent (23.5 million) were lifetime nondrinkers. Over half of lifetime alcohol users (52.7 percent) had used one or more illicit drugs at some time in their life, compared to 8.0 percent of lifetime nondrinkers. Among persons who had used an illicit drug in their lifetime, the average age at first illicit drug use was 19 years for lifetime alcohol users, versus 23 years for lifetime nondrinkers."

(Global Prevalence of Use of Alcohol and Tobacco) "Global estimates suggest that past-month prevalence of tobacco use (25 per cent of the population aged 15 and above) is 10 times higher than past-month prevalence of illicit drug use (2.5 per cent). Annual prevalence of the use of alcohol is 42 per cent (the use of alcohol being legal in most countries), which is eight times higher than annual prevalence of illicit drug use (5.0 per cent). Heavy episodic weekly drinking is eight times more prevalent than problem drug use. Drug use accounts for 0.9 per cent of all disability-adjusted life years lost at the global level, or 10 per cent of all life years lost as a result of the consumption of psychoactive substances (drugs, alcohol and tobacco)."

(Association of Alcohol Use with Tobacco and Other Substance Use in the US, 2013)
" As was the case in prior years, the level of alcohol use was associated with illicit drug use in 2013. Among the 16.5 million heavy drinkers aged 12 or older, 33.7 percent were current illicit drug users. Persons who were not current alcohol users were less likely to have used illicit drugs in the past month (4.3 percent) than those who reported current use of alcohol but no binge or heavy use (7.3 percent), binge use but no heavy use (18.5 percent), or heavy use of alcohol (33.7 percent).
" Alcohol consumption levels also were associated with tobacco use in 2013. Among heavy alcohol users aged 12 or older, 53.1 percent smoked cigarettes in the past month compared with 16.2 percent of non-binge current drinkers and 15.5 percent of persons who did not drink alcohol in the past month. Smokeless tobacco use and cigar use also were more prevalent among heavy drinkers (12.1 and 15.4 percent, respectively) than among non-binge drinkers (2.0 and 3.9 percent) and persons who were not current alcohol users (2.0 and 1.8 percent)."

(Afghan Opiate Use) "Illicit drug use has increased across the country, dramatically so for opium, heroin and other opiates. In four years, the number of regular opium users in Afghanistan grew from 150,000 to approximately 230,000 ‐ a jump of 53 per cent. The numbers are even more alarming for heroin. In 2005, the estimate of regular heroin users in the country was 50,000, compared to approximately 120,000 users in 2009, a leap of 140 per cent. Overall, the annual prevalence of regular opiate use is estimated to be 2.7 per cent of the adult population1 (between 290,000 and 360,000 persons). Opium is by far the most commonly used opiate with an estimated prevalence of about 1.9 per cent of the adult population. Heroin prevalence is estimated to be about 1.0 per cent of the adult population and other opiates users2 are estimated to make up about 0.5 per cent of the adult population."

(Data Limitations Make Estimating Demographics of Heroin Users in the US Difficult) "The prevalence of heroin use is extremely difficult to estimate despite the fact that harm to society associated with heroin marketing and use is substantial. A disproportionate number of heroin users are part of the nonsampled populations in general prevalence surveys (persons with no fixed address, prison inmates, etc.) Also, heroin users are believed to represent less than one half of one percent of our total population, making heroin usage a relatively rare event. Sample surveys are not sensitive enough to measure rare events reliable. Data from the National Household Survey on Drug Abuse (which is considered to produce conservative estimates), indicated that 1.9 percent of blacks, 1.6 percent of Hispanics, and 1.4 percent of whites had ever tried heroin. As will be noted later in this report, the data available from hospital emergency rooms and from drug abuse treatment programs indicated that heroin use is a more serious problem among blacks than whites and Hispanics."

(Global Distribution of Drug Use) "Globally, drug use is not distributed evenly. In general, the US had among the highest levels of use of all drugs. Much lower levels were observed in lower income countries in Africa and the Middle East, and lower levels of use were reported in the Asian locales covered."

(Comparison of US and Europe) "Although statistics on drug use in the United States are not fully reliable, the numbers available indicate that US consumption of cocaine and marijuana has been essentially stable for many years—although considerably reduced from its peak in the 1970s and 1980s. The data also show that, today, the United States consumes illegal substances at a rate some three times that of Europe—although the use of drugs in the EU continues to grow rapidly and a few countries actually consume more per capita than the United States. In both the United States and Europe, the wholesale and street prices of cannabis and cocaine have declined in the past several years, although reportedly their potency has increased and demand remains steady. Across the world, illicit drugs appear to be available at stable or declining prices. A recent EU Commission study concluded that global drug production and use remained largely unchanged during the period from 1998 through 2007."

(Global Estimated Drug-Related Mortality, 2011) "UNODC estimates that there were between 102,000 and 247,000 drug-related deaths in 2011, corresponding to a mortality rate of between 22.3 and 54.0 deaths per million population aged 15-64. This represents between 0.54 per cent and 1.3 per cent of mortality from all causes globally among those aged 15-64.20 The extent of drug-related deaths has essentially remained unchanged globally and within regions."

(Use by Educational Status, 2011) "Illicit drug use in 2011 varied by the educational status of adults aged 18 or older, with the rate of current illicit drug use lower among college graduates (5.4 percent) than those with some college education (10.4 percent), high school graduates (8.9 percent), and those who had not graduated from high school (11.1 percent)."

(Hispanic Population) "In 2010, there were 50.5 million Hispanics in the United States, composing 16 percent of the total population .... Between 2000 and 2010, the Hispanic population grew by 43 percent—rising from 35.3 million in 2000, when this group made up 13 percent of the total population.9 The Hispanic population increased by 15.2 million between 2000 and 2010, accounting for over half of the 27.3 million increase in the total population of the United States."According to the 2010 Census, "'Hispanic or Latino' refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race."

(US Population by Race) "In the 2010 Census, 97 percent of all respondents (299.7 million) reported only one race (see Table 1).10 The largest group reported White alone (223.6 million), accounting for 72 percent of all people living in the United States.11 The Black or African-American alone population was 38.9 million and represented 13 percent of the total population.12 There were 2.9 million respondents who indicated American Indian and Alaska Native alone (0.9 percent). Approximately 14.7 million (about 5 percent of all respondents) identified their race as Asian alone."

(Marijuana Use and Other Illicit Drug Use by 50 Year Old High School Graduates in the US, 2012) "Among 50-year-old high school graduates in 2012, we estimate that about three quarters (74%) have tried marijuana, and that about two thirds (64%) have tried an illicit drug other than marijuana. (These estimates are adjusted to correct for panel attrition, as described in chapter 4 of Volume II.)
"Their current behavior is far less extreme than those statistics might suggest, but it is not by any means negligible. One in eight (12%) indicates using marijuana in the last 12 months, and one in ten (10%) indicates using any other illicit drug in the same period. Their past-month prevalence rates are lower—7.3% and 6.2%, respectively, for marijuana and any other illicit drug. About 1 in 43 (2.3%) is a current daily marijuana user, though substantially more indicate that they have used marijuana daily at some time in the past."

(Current Illegal Substance Use Among Adults 50-64, 2013)
" Among adults aged 50 to 64, the rate of current illicit drug use increased from 2.7 percent in 2002 to 6.0 percent in 2013. For adults aged 50 to 54, the rate increased from 3.4 percent in 2002 to 7.9 percent in 2013 (Figure 2.10). Among those aged 55 to 59, the rate of current illicit drug use increased from 1.9 percent in 2002 to 5.7 percent in 2013. Among those aged 60 to 64, the rate of current illicit drug use increased from 1.1 percent in 2003 and 2004 to 3.9 percent in 2013."

(Baby Boomers) "In 2007, the rate of past year use in this age group [persons aged 50 to 59] was 9.4 percent for any illicit drug, 5.7 percent for marijuana, and 4.0 percent for nonmedical use of prescription drugs. Analyses show that the observed increases are driven primarily by the aging of the baby boom cohort, which has a much higher lifetime illicit drug use rate than earlier cohorts, representing an increasing proportion of persons aged 50 to 59. Less than 3 percent of past year users initiated drug use at ages 50 to 59. Almost 90 percent of past year users initiated drug use before age 30, and many have been continuing users over the years."

Substance Use in the Military

(Illicit Drug Use Among Military Personnel) "The prevalence of any reported illicit drug use (including prescription drug misuse) during the past 30 days declined sharply from 28% in 1980 to 3% in 2002. In 2005, the prevalence of illicit drug use for the past 30 days was 5% and in 2008 it was 12%. Improved question wording in 2005 and 2008 may partially account for the higher observed rates, which are largely attributable to reported increases in misuse of prescription pain medications (see Section 3.3.2 for additional discussion). Because of wording changes, data from 2005 and 2008 are not comparable to data from prior surveys and are not included as part of the trend line. An additional line from 2002 to 2008 shows estimates of illicit drug use excluding prescription drug misuse. As shown, those rates were very low (2% in 2008) and did not change across these three iterations of the survey."

(Heavy Alcohol Use Among Military Personnel) "Heavy alcohol use in the past 30 days decreased between 1980 and 1988, remained relatively stable with some fluctuations between 1988 and 1998, showed a significant increase from 1998 to 2002, and remained at that same level in 2005 (19%) and 2008 (20%). However, taken together, heavy alcohol use over the decade from 1998 to 2008 showed an increasing pattern (15% to 20%). The heavy drinking rate for 2008 (20%) was not significantly different from when the survey series began in 1980 (21%)."

(Positive Drug Tests) "Given that illicit drug use is inconsistent with Army Values, one would not expect the presence of multiple and serial drug offenders in the Army. Data for FY 2001 – FY 2009 indicate otherwise.76 Drug testing results reveal that of the total number of Soldiers tested, 3.5% (58,687 of 1,662,004) were positive for illicit drug use (see Table 7, page 50). That includes Soldiers who tested positive one, two or three or more times. When separated into these specific categories, 36,470 (62%) were first time positives, 11,828 (20%) were multiple, and 10,389 (18%) were serial offenders."

(Drug-Positive Rates In US Military) "While the overall illicit drug use rate is holding constant, the number of MRO reviews is increasing (includes legitimate prescription drug use and positive UAs for other pharmaceutical drugs; see Figure 15, page 54). As previously noted, current policy governing prescription drug use may be masking illicit drug use due to open-ended prescriptions. Overall use of amphetamines (including both legal and illegal) is growing at a rate of 2.8 percent per year for all COMPOS. This means that by the end of next year it is expected that there will be over 5,000 MRO [Medical Regulating Officer] reviewable positive tests for amphetamines alone. Among the street drugs, marijuana is increasing significantly within the National Guard population. In fact, if we look at the rate of THC positives over the last four years, it is predicted that over 7,500 Guard Soldiers will test positive for THC this year."

(Tobacco Use Among Military Personnel) "For the DoD services, the percentage of military personnel who smoked cigarettes in the past 30 days decreased significantly from 51% in 1980 to 30% in 1998. It increased significantly from 1998 (30%) to 2002 (34%), and while not showing significant declines in 2005 (32%) and in 2008 (31%), has been slowly trending downward since 2002."

(Binge Drinking Among Military Personnel) "In 2008, 47% of all DoD services personnel were binge drinkers. For all DoD services, binge drinking increased between 1998 and 2008 but was stable between 2005 and 2008.
"For each service, binge drinking also increased overall between 1998 and 2008. Between 2005 and 2008, binge drinking rates significantly increased for the Navy and the Air Force and were stable for the Army and the Marine Corps."

(Heavy Drinking, Military Personnel Compared with Civilian Population) "Military personnel aged 18 to 25 showed significantly higher rates of heavy drinking (26%) than did civilians (16%).
"Likewise, military personnel aged 26 to 35 showed higher rates of heavy drinking (18%) than did their civilian counterparts (11%). For those aged 36 to 45, this rate was slightly higher for military personnel than civilians (10% vs. 8%) though this difference did not reach statistical significance.
"Among those aged 46 to 64, military personnel exhibited lower rates of heavy alcohol use (4%) than did civilians (9%).
"Across all age groups, military personnel showed significantly higher rates of heavy drinking (20%) than did civilians (14%)."

(Drug Use by Veterans, 2003) "In 2003, there were an estimated 25 million veterans comprising roughly 11.5 percent of the 217 million non-institutionalized civilians aged 17 or older in the United States."
"An estimated 3.5 percent of veterans used marijuana in the past month compared with 3.0 percent of their nonveteran counterparts in 2003"
"Heavy use of alcohol was more prevalent among veterans than comparable nonveterans, with an estimated 7.5 percent of veterans drinking heavily in the past month compared with 6.5 percent of their nonveteran counterparts."
"Using criteria from the DSM-IV, an estimated 2.6 percent of veterans were dependent on alcohol in the past year (Figure 2). A much smaller proportion of veterans (0.9 percent) was dependent on illicit drugs in the past year."
"An estimated 0.8 percent of veterans received specialty treatment4 for a substance use disorder (alcohol or illicit drugs) in the past year compared with 0.5 percent of their nonveteran counterparts (Figure 3). An estimated 2.8 percent of veterans were dependent on illicit drugs or alcohol but did not receive treatment in the past year.5 A similar proportion of comparable nonveterans went untreated."

Sociopolitical Research

(Alcohol and Other Drug Use and Employment) "There were little or no differences in the probability of employment by lifetime alcohol and drug use patterns. Men who had an alcohol disorder at some point in their life were equally likely as men who had never drunk alcohol to be currently employed (.91) and only slightly less likely than moderate alcohol users (.91 vs. .92, p=.09). Similarly, men who had a drug disorder at some point in their life were somewhat less likely (.90 vs. 92, p=.07) to be currently employed, but there was no statistically difference between moderate drug users and non-users. Differences among men by their current (last 12 months) alcohol and, especially, drug use patterns were greater. Current moderate alcohol drinkers were actually more likely than those who had not drunk alcohol in the last year to be employed (.93 vs. 91), while those with a current alcohol problem were less likely to be employed than either moderate or nondrinkers (.89). In contrast to moderate alcohol users, current moderate drug users were less likely to be employed than nonusers (.88 vs. .92). Men with a current drug problem were substantially less likely to be employed (.82) than either moderate or non drug users."

(Use Unrelated to Enforcement) "Opponents of drug policy reform commonly argue that drug use would increase if health-based models were emphasized over drug law enforcement,14 but we are unaware of any research to support this position. In fact, a recent World Health Organization study demonstrated that international rates of drug use were unrelated to how vigorously drug laws were enforced, concluding that 'countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones.'15"

(Progression of Drug Use Among Young Adults in Large Cities in the US) "In conclusion, patterns of prescription drug misuse among high-risk young adults in LA and NY appear to conform to and be shaped by differences in local markets for illicit drugs in each city. Our findings indicate that current misuse of prescription drugs in both cities encompasses a broad range of practices, such as sniffing, injecting, polydrug use, and drug substitution, and involves frequent misuse of illicit substances. Initiation into prescription drug misuse was often preceded by being prescribed one or more types of prescription drugs, which was then followed by initiating illicit drugs with similar psychotropic effects."

(Global Burden of Disease, Mental Health, and Substance Use Disorders) "In 2010, mental and substance use disorders accounted for 183·9 million DALYs [Disability-Adjusted Life Years] (95% UI 153·5 million–216·7 million), or 7·4% (6·2–8·6) of all DALYs worldwide. Such disorders accounted for 8·6 million YLLs [Years of Life Lost] (6∙5 million–12∙1 million; 0·5% [0·4–0·7] of all YLLs) and 175∙3 million YLDs [Years Lived with Disability] (144∙5 million–207∙8 million; 22·9% [18·6–27·2] of all YLDs). Mental and substance use disorders were the leading cause of YLDs worldwide. Depressive disorders accounted for 40·5% (31·7–49·2) of DALYs caused by mental and substance use disorders, with anxiety disorders accounting for 14·6% (11·2–18·4), illicit drug use disorders for 10·9% (8·9–13·2), alcohol use disorders for 9·6% (7·7–11·8), schizophrenia for 7·4% (5·0–9·8), bipolar disorder for 7·0% (4·4–10·3), pervasive developmental disorders for 4·2% (3·2–5·3), childhood behavioural disorders for 3·4% (2·2–4·7), and eating disorders for 1·2% (0·9–1·5). DALYs varied by age and sex, with the highest proportion of total DALYs occurring in people aged 10–29 years. The burden of mental and substance use disorders increased by 37·6% between 1990 and 2010, which for most disorders was driven by population growth and ageing."

(Chronic Substance Use and Employment) "In conclusion, this study found that chronic drug use was significantly related to employment status for men and women. On the other hand, male chronic drug users were less likely to participate in the labor force, but no significant relationship existed between chronic drug use and labor force participation for females. Perhaps the most important finding of this study, however, was the lack of any significant relationships between nonchronic drug use, employment, and labor force participation. An implication of this finding is that employers and policy makers should focus on problematic drug users in the same way that they focus on problematic alcohol users."

(Impact of Decriminalization) "The information we have presented adds to the current literature on the impacts of decriminalization. It disconfirms the hypothesis that decriminalization necessarily leads to increases in the most harmful forms of drug use. While small increases in drug use were reported by Portuguese adults, the regional context of this trend suggests that they were not produced solely by the 2001 decriminalization. We would argue that they are less important than the major reductions seen in opiate-related deaths and infections, as well as reductions in young people’s drug use. The Portuguese evidence suggests that combining the removal of criminal penalties with the use of alternative therapeutic responses to dependent drug users offers several advantages. It can reduce the burden of drug law enforcement on the criminal justice system, while also reducing problematic drug use."

Source:

Hughes, Caitlin Elizabeth and Stevens, Alex, "What can we learn from the Portugese decriminalization of drugs?" British Journal of Criminology (London, United Kingdom: Centre for Crime and Justice Studies, November 2010), Vol. 50, Issue 6, p. 1018.http://bjc.oxfordjournals.org/content/50/6/999.full.pdf

(Marijuana Decriminalization and Substitution Effects) "In conclusion, our results suggest that participation in the use of both licit and illicit drugs is price sensitive. Participation is sensitive to own prices and the price of the other drugs. In
particular, we conclude that cannabis and cigarettes are complements, and there is some evidence to suggest that cannabis and alcohol are
substitutes, although decriminalization of cannabis corresponds with higher alcohol use. Alcohol and cigarettes are found to be complements.
"The results also show that the liberalized legal status of cannabis in South Australia coincides with higher cannabis participation on average over the period under investigation. In South Australia, where possession of small amounts of cannabis is no longer a criminal offence, the probability of use is estimated to be 2.0 percentage points higher than elsewhere based on the pooled sample of data. Further investigation revealed that although participation increased in South Australia shortly after the liberalization of the cannabis laws, the effect of decriminalization was transitory and had disappeared in seven years. In addition, our results indicate that the increase in participation was due to individuals over 30 delaying giving up cannabis use as a result of its changed legal status, not an increase in use
by younger people. This finding provides an explanation of why US studies based on youth fail to find that decriminalization has an impact on
the probability of cannabis use, while studies based on adults and youth, or just adults, do find a positive association between decriminalization and participation in cannabis use."

(Use in Low Income Areas) "Although residents of disadvantaged neighborhoods, neighborhoods with high concentrations of minorities, and neighborhoods with high population densities reported much higher levels of visible drug sales, they reported only slightly higher levels of drug use, along with somewhat higher levels of drug dependency. This finding indicates that conflating drug sales with use, so that poor and minority areas are assumed to be the focus of the problem of drug use, is plainly wrong. The finding is based on the data collected across 41 sites, including city and suburban (but not rural) areas in all regions."

(Occupational Injury) "We conclude that there is an association between substance use and occupational injury. This association is stronger for males and in certain industries, such as manufacturing and construction, and may also be stronger for younger workers, though future research is needed on this last point. The proportion of injuries caused by substance use, however, is relatively small. Instead, there is mounting evidence that harmful substance use is one of a constellation of behaviors exhibited by certain individuals who may avoid work-related safety precautions and take greater work-related risks. Thus, we suspect that it is more likely that risk-taking dispositions, often termed deviance proneness, and other omitted factors can explain most empirical associations between substance use and injuries at work."

(Income and Relationship Status) "Legal and illegal use of drugs was most strongly associated with age, sex, and income. Higher income was associated with a greater likelihood of drug use for all drug types examined, which is perhaps not surprising given that drug use requires disposable income. Relationship status was linked to illegal (but not legal) drug use: both cocaine and cannabis use were more likely among persons who had never been married or previously been married."

(Disadvantaged Areas) "Although serious drug use is slightly more prevalent in poor minority neighborhoods than elsewhere, the major problem for disadvantaged neighborhoods is drug distribution. These communities are victims not only of their own drug abuse but also of a criminal drug market that serves the entire society. The market establishes itself in disadvantaged communities in part because of the low social capital in these neighborhoods. The drug economy further erodes that social capital."

(Limited Effects of Punitive Drug Policies) "The use of drugs seems to be a feature of more affluent countries. The US, which has been driving much of the world’s drug research and drug policy agenda, stands out with higher levels of use of alcohol, cocaine, and cannabis, despite punitive illegal drug policies, as well as (in many US states), a higher minimum legal alcohol drinking age than many comparable developed countries. The Netherlands, with a less criminally punitive approach to cannabis use than the US, has experienced lower levels of use, particularly among younger adults. Clearly, by itself, a punitive policy towards possession and use accounts for limited variation in nation level rates of illegal drug use."

(Stigmatization) "Because the impacts of problem drug users are largely hidden, and also because their number is actually relatively small (approximately 330,000; Hay et al., 2008),22 people’s understanding of problem drug use tends to come from remote sources – the media (including the internet, television, films, magazines and books) and anecdote – rather than from direct experience. This provides fertile ground for the growth of myths and stereotypes: for example, the prevalent belief in instant addiction and the myth of the drug dealer offering free drugs at the school gates."

(Sewage Testing) "Some scientists have recently turned to the sewer to develop a more accurate estimate of drug use. They examine tiny samples of raw sewage for the presence of illicit drugs and their metabolites in a science known as sewer epidemiology.4 These samples are essentially a diluted urine test collected from an entire community,5 making them akin to a “community urinalysis.”6 The basic science is simple: nearly every drug ingested into the body is eventually excreted and finds its way into the sewer system, allowing scientists to profile a community’s drug use based on objective data."

Source:

Hering, Christopher L., "Flushing the Fourth Amendment Down the Toilet: How Community Urinalysis Threatens Individual Liberty," Arizona Law Review (Tuscon, AZ: The University of Arizona, James E. Rogers College of Law, 2009) Volume 51, Issue 3, p. 742.http://www.arizonalawreview.org/pdf/51-3/51arizlrev741.pdf

Monitoring the Future Survey

(MTF History) "Monitoring the Future, now having completed its 39th year of data collection, has become one of the nation’s most relied-upon scientific sources of valid information on trends in use of licit and illicit psychoactive drugs by American adolescents, college students, young adults, and adults up to age 55. During the last nearly four decades, the study has tracked and reported on the use of an ever-growing array of such substances in these populations.
"This annual series of monographs is the primary mechanism through which the epidemiological findings from MTF are reported. Findings from the inception of the study in 1975 through 2013 are included—the results of 39 national in-school surveys and 37 national follow-up surveys.
"MTF has conducted in-school surveys of nationally representative samples of (a) 12th-grade students each year since 1975 and (b) 8th- and 10th-grade students each year since 1991. In addition, beginning with the class of 1976, the project has conducted follow-up mail surveys on representative subsamples of the respondents from each previously participating 12th-grade class. These follow-up surveys now continue well into adulthood, currently up to age 55."

(Long Term Trends In Prevalence of Marijuana Use Among Youth) "We know from some of our own earlier work and from other studies that in the late 1960s and early 1970s, prior to the launching of MTF, marijuana use rose quite sharply from relatively negligible levels in the youth population.46 Based on MTF data, 1978 and 1979 marked the crest of this long and dramatic rise in marijuana use among American 12th graders (and, for that matter, among young people generally). As Tables 5-2 and 5-3 and Figure 5-4a illustrate, annual and 30-day prevalence of marijuana use leveled in 1978-1979, and in 1980 both statistics dropped for the first time. They continued to decline every year through 1992, except for a brief pause in 1985. Following this 12-year decline, the annual prevalence of marijuana use among 12th graders rose sharply beginning in 1993 in what we have termed the 'relapse phase' in the drug epidemic, nearly doubling from 22% to 39% between 1992 and 1997. Thirty-day prevalence also rose significantly, doubling from the 1992 level of 12% to 24% in 1997. In 1998 these use rates began to turn around and by 2007, 30-day prevalence had declined to 19%. Annual prevalence declined to 32%, still only modestly lower than the recent peak level but considerably below the original peak in 1979. There were nonsignificant increases of 0.7 percentage points in both measures in 2008—an increase that we suggested five years ago could mark the end of the long, gradual decline in marijuana use that we had observed for about the previous seven years. Since then marijuana use has increased in all three grades, with annual prevalence in 2013 standing at 17%, 36%, and 46% in grades 8, 10, and 12, respectively, and 30-day prevalence at 13%, 30%, and 36%, respectively.
"Lifetime prevalence of marijuana use by 12th graders peaked in 1979 and 1980 at 60%; it first began to drop after 1980, though more gradually than annual or 30-day use did.47 Lifetime prevalence reached a low of 33% in 1992—in other words, only one third of the students in that class cohort had ever tried marijuana—but, during the relapse phase in the illicit drug epidemic, it increased to 50% among 12th graders by 1997. Their lifetime use remained level between 1997 and 2001 and then declined, dropping to 42% for the class of 2007 — a modest improvement. Since then, prevalence has increased to 46% in 2013."

(Alcohol Use Among US Youth)
"Alcohol use by the nation's teens continued its long-term decline in 2014. All three grades showed a decline in the proportion of students reporting any alcohol use in the 12 months prior to the survey; the three grades combined dropped from 43 percent to 41 percent, a statistically significant change.
"'Since the recent peak rate of 61 percent in 1997, there has been a fairly steady downward march in alcohol use among adolescents,' said Lloyd Johnston, the study's principal investigator. 'The proportion of teens reporting any alcohol use in the prior year has fallen by about a third.'
"Of perhaps greater importance, the proportion of teens who report 'binge drinking' — that is, consuming five or more drinks in a row at least once in the two weeks preceding the survey — fell significantly again this year to 12 percent for the three grades combined. This statistic is down from a recent high point of 22 percent in 1997. While this is an important improvement, say the investigators, still roughly one in five (19 percent) 12-graders report binge drinking at least once in the prior two weeks.
"Some 12th-graders drink even more heavily, reporting having 10 or more, or 15 or more, drinks in a row on at least one occasion in the prior two weeks. Since 2005 (the first year that this 'extreme binge drinking' was measured), these measures also have declined, from 11 percent to 7 percent in 2014 for 10 or more drinks, and from 6 percent to 4 percent for 15 or more drinks."

(Cigarette Use Among US Youth)
"Cigarette smoking also reached historical lows among teens in 2014 in all three grades. For the three grades combined, 28 percent reported any smoking in the prior month in 1997, the recent peak year, but that rate was down to 8 percent in 2014.
"'The importance of this major decline in smoking for the health and longevity of this generation of young people cannot be overstated,' Johnston said.
"As with alcohol, there has been a substantial reduction in the proportion of students who say cigarettes are easy for them to get, and this decline continued into 2014. Increasing disapproval of smoking also has accompanied the decline in use, as well as an increased perception that smoking carries a 'great risk' for the user. However, there were only modest further increases in these factors in 2014."

(Illegal Use of Prescription Drugs and Narcotics Other Than Heroin Among US Youth)
"Any prescription drug misuse includes use of narcotics, sedatives, tranquilizers, and/or amphetamines without medical supervision. It has been of considerable public health concern in recent years, because most of these drugs showed a substantial increase in use in the 1990s, which then continued into the first decade of the 2000s, when many of the illegal drugs already were in decline.
"Only 12th-graders report on their use of all of these drugs; they show a statistically significant decline between 2013 and 2014, from 16 percent to 14 percent, saying that they used one or more of these prescription drugs in the 12 months prior to the survey. The gradual turnaround began after 2005, when 17 percent indicated misuse of any of these drugs.
"'It's not as much progress as we might like to see, but at least the number of students using these dangerous prescription drugs is finally declining,' Johnston said.
"Narcotic drugs other than heroin—among the most dangerous of the prescription drugs—have been declining in use by 12th-graders since 2009, when 9 percent indicated using them without medical supervision in the prior 12 months. Their use continued to drop significantly, from 7 percent in 2013 to 6 percent in 2014. Use of these drugs is reported only for 12th grade; students are reporting that these drugs are increasingly difficult to obtain.
"Use in the prior 12 months of the specific narcotic analgesic OxyContin also declined this year, significantly so in 8th grade. OxyContin use reached a recent peak among adolescents around 2009 and use has declined since then in all three grades. The 2014 reports of use in the past 12 months stand at 1.0 percent, 3.0 percent and 3.3 percent in grades 8, 10 and 12, respectively."

(Effects of Decriminalization on Adolescent Use) "A study of the effects of decriminalization by several states during the late 1970s found no evidence of any impact on the use of marijuana among young people, nor on attitudes and beliefs concerning its use.88 However, it should be noted that decriminalization falls well short of the full legalization posited in the questions here. Moreover, the situation today is very different from the one in the late 1970s, with more peer disapproval and more rigorous enforcement of drug laws, at least until very recently. Some recent studies suggest that there might be an impact of decriminalization, because 'youths living in decriminalized states are significantly more likely to report currently using marijuana.'89 As more states adopt decriminalization or full legalization for adults, (as occurred in 2012 in Colorado and the state of Washington), it seems quite possible that attitudes about and use of marijuana will change. Declines in perceived risk and disapproval of marijuana would seem the most likely attitudinal changes, and such changes may well lead to increased use among youth."

(Perceived Availability of Alcohol, Tobacco, and Other Drugs Among US Youth)
" Substantial differences were found in perceived availability of the various drugs. In general, the more widely used drugs are reported to be available by higher proportions of the age group, as would be expected (see Tables 9-6, 9-7, and 9-8). Also, older age groups generally perceive drugs to be more available. For example, in 2013, 39% of 8th graders said marijuana would be fairly easy or very easy to get (which we refer to as 'readily available'), versus 70% of 10th graders and 81% of 12th graders. In fact, compared to 8th graders, the proportion of 12th graders indicating that drugs are available to them is two to four times as high for other drugs included in the study and five times as high for narcotics other than heroin. (Tranquilizers, on the other hand, are reported as only a little less available by 8th graders.) Both associations are consistent with the notion that availability is largely attained through friendship circles. (A section in Chapter 10 documents where 12th graders obtain prescription drugs that are not medically prescribed, and friends clearly are the leading source.) The differences among age groups may also reflect less willingness and/or motivation on the part of those who deal drugs to establish contact with younger adolescents. Because many inhalants — such as glues, butane, and aerosols — are universally available, we do not ask about their availability. See Table 9-8 for the full list of drugs included in the questions for 12th graders; a few of these drugs were not asked of the younger students (see Tables 9-6 and 9-7).
" Measures on the availability of cigarettes are not included in the 12th-grade questionnaires because we have assumed that they are almost universally available to this age group. However, data on this measure are collected from 8th and 10th graders, which clearly show that cigarettes are readily available to most of them. In 2013, 50% of 8th graders and 71% of 10th graders thought that cigarettes would be fairly easy or very easy for them to get if they wanted some.
" The great majority of teens also see alcohol as readily available: In 2013, 56% of 8th graders, 77% of 10th graders, and 90% of 12th graders said it would be fairly easy or very easy to get."

(Attitudes of Young People Toward Legalization of Marijuana)
" Table 8-8 lists the proportions of 12th graders in 2013 who favor various legal consequences for marijuana use: making it entirely legal (42%), a minor violation like a parking ticket but not a crime (25%), or a crime (21%). The remaining 13% said they 'don’t know.' It is noteworthy just how variable attitudes about this contentious issue are.
" Asked whether they thought it should be legal to sell marijuana if it were legal to use it, about three in five (61%) said 'yes.' However, about 85% of those answering 'yes' (52% of all respondents) would permit sale only to adults. A small minority (9%) favored the sale to anyone, regardless of age, while 29% said that sale should not be legal even if use were made legal, and 10% said they 'don’t know.' Thus, while the majority subscribe to the idea of legal sale, if use is allowed, the great majority agree with the notion that sale to underage people should not be legal."

(Perceived Effect of Legalization on Youth) "Most 12th graders felt that they would be little affected personally by the legalization of either the sale or the use of marijuana. Over half (56%) of the respondents said that they would not use the drug even if it were legal to buy and use, while others indicated they would use it about as often as they do now (15%) or less often (1.5%). Only 9% said they would use it more often than they do at present, while 10% thought they would try it. Another 9% said they did not know how their behavior would be affected if marijuana were legalized. Still, this amounts to 19% of all seniors, or about one in five, who thought that they would try marijuana, or that their use would increase, if marijuana were legalized."

(Trends in Attitudes of US 12th Graders Toward Legalization of Any Illegal Drugs)
" From 1975 through 1978, there were modest declines (shifts of five to seven percentage points, depending on the substance) in the proportions of 12th graders who favored legal prohibition of private use of any of the five illicit drugs (see Table 8-7). But by 1990 (12 years later), all of these proportions had increased substantially, with shifts of 8 to 31 percentage points. The proportion who thought marijuana use in private should be prohibited by law more than doubled, from 25% in 1978 to 56% in 1990—a dramatic shift.
" Then, between 1990 and 1997, positions on prohibition of all illicit drug use softened once again, particularly in the case of marijuana use in private. After 1997 these attitudes were fairly stable, or continued to soften slightly. For example, in 2013, 69% thought taking amphetamines or sedatives (barbiturates) in public should be prohibited, down from 77% in 1997.
" One important change in these attitudes that occurred after 2006 is increased tolerance for the use of marijuana in private, as the proportion favoring prohibition declined from 42% in 2006 to 32% in 2013. Tolerance for public use of marijuana increased after 2008, when 70% thought such use should be prohibited, dropping to 61% by 2013.
" The proportions favoring prohibitions on the use in private of some other drugs have also declined since about 2007, including LSD (from 64% to 58% in 2013), amphetamines or sedatives (barbiturates) (from 54% to 49%), and heroin (from 73% to 71%)."

(Effectiveness of Supply Reduction) "Overall, supply reduction — that is, reducing the availability of drugs — does not appear to have played as major a role as many had assumed in four of the five most important downturns in illicit drug use that have occurred to date, namely, those for marijuana, cocaine, crack, and ecstasy (see, for example, Figures 8-4, 8-5, and 8-6). In the case of cocaine, perceived availability actually rose during much of the period of downturn in use. (These data are corroborated by data from the Drug Enforcement Administration on trends in the price and purity of cocaine on the streets.96) For marijuana, perceived availability has remained very high for 12th graders since 1976, while use dropped substantially from 1979 through 1992 and fluctuated considerably thereafter. Perceived availability for ecstasy did increase in parallel with increasing use in the 1990s, but the decline phase for use appears to have been driven much more by changing beliefs about the dangers of ecstasy than by any sharp downturn in availability. Similarly, amphetamine use declined appreciably from 1981 to 1992, with only a modest corresponding change in perceived availability. Finally, until 1995, heroin use had not risen among 12th graders even though availability had increased substantially.
" What did change dramatically were young peoples’ beliefs about the dangers of using marijuana, cocaine, crack, and ecstasy. We believe that increases in perceived risk led to a decrease in use directly through their impact on young people’s demand for these drugs and indirectly through their impact on personal disapproval and, subsequently, peer norms. Because the perceived risk of amphetamine use was changing little when amphetamine use was declining substantially (1981–1986), other factors must have helped to account for the decline in demand for that class of drugs—quite conceivably some displacement by cocaine. Because three classes of drugs (marijuana, cocaine, and amphetamines) have shown different patterns of change, it is highly unlikely that a general factor (e.g., a broad shift against drug use) can explain their various trends.
" The increase in marijuana use in the 1990s among 12th graders added more compelling evidence to this interpretation. It was both preceded and accompanied by a decrease in perceived risk. (Between 1991 and 1997, the perceived risk of regular marijuana use declined 21 percentage points.) Peer disapproval dropped sharply from 1993 through 1997, after perceived risk began to change, consistent with our interpretation that perceived risk can be an important determinant of disapproval as well as of use. Perceived availability remained fairly constant from 1991 to 1993 and then increased seven percentage points through 1998."

(Comparison of Youth Substance Use in the US and EU) "The concept of 'illicit drugs' includes marijuana, hashish, amphetamines, cocaine, crack, ecstasy, GHB, LSD or other hallucinogens, and heroin. GHB has been added to this list since the 2007 ESPAD report. Reported use of any of these illicit drugs varies considerably across the ESPAD countries. In the Czech Republic, 43% of the students report having used any of the drugs in question at least once, which is more than twice the ESPAD average of 18%. Students in France, Monaco and the United States (not an ESPAD country) also exhibit high levels of experience with illicit drugs (38–39%)."

(Drug Use Comparisons Between EU and US) "On average, 7% of the ESPAD students stated that they had used marijuana or hashish during the past 30 days. As a proportion of the group reporting lifetime use, this corresponds to roughly four in ten. The highest rates of past-30-days cannabis use are found in the two neighbouring countries of France and Monaco (24% and 21%, respectively), followed by the United States (not an ESPAD country) (18 %) and the Czech Republic and Spain (not an ESPAD country) (15% each). In these top countries, about 10% of all students had used cannabis at an average frequency roughly corresponding to at least once a week during the period in question (3–5 times or more in the past 30 days). This proportion is considerably larger than the average for all ESPAD countries (4%)."

(Any Drug Use vs Specific Drug Use) "Overall, these data reveal that, while use of individual drugs (other than marijuana) may fluctuate widely, the proportion using any of them is much more stable. In other words, the proportion of students prone to using such drugs and willing to cross the normative barriers to such use changes more gradually. The usage rate for each individual drug, on the other hand, reflects many more rapidly changing determinants specific to that drug: how widely its psychoactive potential is recognized, how favorable the reports of its supposed benefits are, how risky its use is seen to be, how acceptable it is in the peer group, how accessible it is, and so on."

Estimated Lifetime Prevalence of Substance Use in the US by Those Aged 12 and Older (Numbers in Thousands)

Lifetime Use

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

% Population Using Illicit Drugs

46.0%

46.4%

45.8%

46.1%

45.4%

46.1%

47.0%

47.1%

47.3%

47.0%

48.0%

All Illicit Drugs

108,255

110,205

110,057

112,085

111,774

114,275

117,325

118,705

119,933

121,078

124,808

Marijuana and Hashish

94,946

96,611

96,772

97,545

97,825

100,518

102,404

104,446

106,613

107,842

111,239

Cocaine

33,910

34,891

34,153

33,673

35,298

35,882

36,773

36,599

37,361

36,921

37,688

Crack

8,402

7,949

7,840

7,928

8,554

8,581

8,445

8,359

9,208

8,214

9,015

Heroin

3,668

3,744

3,145

3,534

3,785

3,780

3,788

3,683

4,144

4,162

4,565

Hallucinogens

34,314

34,363

34,333

33,728

35,281

34,215

35,963

37,256

37,544

36,362

37,908

Ecstasy

10,150

10,904

11,130

11,495

12,262

12,426

12,924

14,234

15,929

14,570

16,162

Psychotherapeutics

47,958

49,001

49,157

49,571

50,965

50,415

51,970

51,771

51,832

51,243

54,389

Pain Relievers

29,611

31,207

31,768

32,692

33,472

33,060

34,861

35,046

34,908

34,247

37,045

Methamphetamine

15,365

15,139

14,512

12,663

14,206

13,065

12,598

12,837

13,060

11,928

12,259

Any Illicit Drug Other Than Marijuana

70,300

71,128

70,657

71,822

72,906

73,494

75,573

75,780

76,472

75,447

78,034

Alcohol

195,452

197,533

198,220

201,667

203,368

203,976

205,404

208,545

209,264

211,747

214,013

Tobacco

171,838

172,843

171,827

172,217

173,921

173,921

173,927

174,119

174,409

173,890

173,654

Notes:
 "Psychotherapeutics" include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included.
 Methodological changes make comparison of survey data from different years problematic.
 The shift to 2010 census data from 2000 could affect comparisons between substance use estimates in 2011 and those from prior years, particularly with respect to some demographic groups.

Estimated Prevalence of Past-Month Substance Use in US by Those Aged 12 and Older (Numbers In Thousands)

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

All Illicit Drugs

19,522

19,470

19,071

19,720

20,357

19,857

20,077

21,813

22,648

22,454

23,863

Marijuana and Hashish

14,584

14,638

14,576

14,626

14,813

14,448

15,203

16,718

17,409

18,071

18,855

Cocaine

2,020

2,281

2,021

2,397

2,421

2,075

1,855

1,637

1,472

1,369

1,650

Crack

567

604

467

682

702

610

359

492

378

228

443

Heroin

166

119

166

136

338

153

213

195

239

281

335

Hallucinogens

1,196

1,042

929

1,088

1,006

996

1,060

1,258

1,207

972

1,134

Ecstasy

676

470

450

502

528

503

555

760

691

544

628

Psychotherapeutics

6,287

6,451

6,110

6,491

7,095

6,895

6,224

6,953

6,957

6,119

6,831

Pain Relievers

4,377

4,693

4,404

4,658

5,220

5,174

4,747

5,257

5,093

4,471

4,862

Methamphetamine

683

726

706

628

731

529

314

502

353

439

440

Illicit Drugs Other Than Marijuana

8,777

8,849

8,247

8,963

9,615

9,270

8,565

9,157

9,016

8,020

8,883

Alcohol

119,820

118,965

120,934

126,028

125,309

126,760

128,974

130,621

131,374

133,385

135,502

Heavy Alcohol Use

15,860

16,144

16,689

16,035

16,946

17,010

17,292

17,129

16,899

15,865

17,021

Tobacco

71,499

70,757

70,257

71,519

72,873

70,939

70,868

69,713

69,663

68,225

69,497

Notes:
 "Psychotherapeutics" include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included.
 “Heavy” alcohol use is defined as drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days.
 Methodology changes make comparison between different survey years problematic.
 The shift to 2010 census data from 2000 could affect comparisons between substance use estimates in 2011 and those from prior years, particularly with respect to some demographic groups.

Notes:
 "Psychotherapeutics" include the nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included.
 “Heavy” alcohol use is defined as drinking five or more drinks on the same occasion on each of 5 or more days in the past 30 days.
 NSDUH reports did not begin reporting Ecstasy user data until 2001, making 2002 the first year for which a percent change over the prior year could be computed.